Infants help caregivers and unfamiliar others by their first birthday. Yet, developmental pathways leading to helping are largely unknown. This longitudinal study (6, 10, 14 months) investigated the association of caregiver-child interaction quality, motor development, action anticipation, and caregiver encouragement and modeling with helping (N = 118, 49 female, mostly White, European, data collection 2020-2022). Path models showed that helping the mother was related to motor development and maternal modeling, while helping the experimenter was related to motor development, action anticipation, and maternal interaction quality. This study provides novel evidence for a developmental systems approach to helping, emphasizing that early helping behavior is shaped by the caregiver-child interaction and interwoven with both motor and social development. Infants help others from around their first birthday. For example, they engage in household tasks with their caregiver and they pick up dropped objects for an unfamiliar adult. The current study showed how infants' helping behavior is associated with motoric and social-cognitive skills as well as early interactions with the caregiver. The more motorically developed infants were and the better they understood others' goals, the more they helped others. The more caregivers modeled the required behavior, the more infants helped the caregiver. The study is in line with the theoretical proposal that infants come to help others by engaging in interactive routines with their caregiver, which are influenced by their motoric skills.
In April 2024, two cases of hepatitis A (HA) were linked to the consumption of oysters produced in the same region, which triggered a multidisciplinary study. A network was quickly set up in a one-health approach including epidemiological and clinical data, as well as analysis of locally collected shellfish and wastewater samples. By the end of the outbreak, up to 17 HA cases met the case definition: all shared a same genotype IA strain and have eaten oysters. The prompt response enabled the identification of oyster samples positive for the HAV genome at the start of the monitoring period; these oyster samples subsequently tested negative during the following two months of the sampling campaign. Monitoring three nearby wastewater treatment plants revealed that the contamination was limited to a single area, allowing for more effective monitoring of shellfish. None of the identified cases lived in the area served by the treatment plant, and no clinical cases were detected among the local population, either before or after the outbreak. The decline of HAV concentration in sewage signed the end of the outbreak. While predicting contamination of shellfish growing areas is complicated, sewage surveillance can help establishing an alert system to prevent shellfish contamination, which is an important issue for silent diseases.
New graduate nurses experience transition shock during the first year of their professional lives. Limited prior studies have shown how transition shock affects freshly graduated nurses' ability to provide care, but further evidence related to missed care is required. This study is a report that evaluates the relationship between transition shock experienced and missed nursing care among new graduate nurses. This descriptive and correlational study involved 277 new graduate nurses working in four hospitals. Data were collected using two standardised scales: the MISSCARE Survey and the Nursing Transition Shock Scale. The data were collected from December 2023 to February 2024. The data were analysed using Pearson correlation and multiple regression. Transition shock was significantly associated with missed nursing care practices and the causes of missed nursing. Transition shock was significantly associated with human resources, material resources and communication. These results showed that transition shock significantly predicted missed nursing care practices and their causes. The study highlighted that the transition shock of new graduate nurses is associated with missed nursing care. To prevent missed care by new graduate nurses, the determinants should be considered when providing nursing care. According to the study's conclusions, helping recently graduated nurses with continuing education and mentoring may have beneficial effects on preventing missed care. Adhered to the STROBE guidelines. No patient or public contribution.
Since the first edition in November 2011 initiated by ICRP, 25 Fukushima dialogue meetings have been held in 12 different municipalities of the Fukushima Prefecture. Based on the Belarus experience in the 1990s and 2000s as part of the rehabilitation of living conditions in the territories contaminated by the Chernobyl accident, the dialogue meetings are offering a fair and transparent forum to share concerns, values and opinions in mutual respect and equal opportunity not only between local residents, but also with experts, government officials, and people from various groups and organisations from Japan and abroad. The Fukushima Dialogue clearly underlined that beyond the fear of radiation, the challenge after a nuclear accident is to empower the affected people to allow them to gradually acquire a practical culture of radiation protection helping them to regain their dignity and project themselves again into the future. The dialogue meetings emphasised that technical risk communication, however precise and substantiated it may be, is not sufficient to address the questions and concerns of those affected by the accident in a context of distrust.
Iron(III) (oxyhydr)oxides are the major sink for PO43- in freshwater sediments, helping to control the onset of eutrophic conditions when PO43- is in excess; however, this sink is transient as ferrous iron and PO43- are typically released when sediments become anoxic, triggering a self-sustaining reversible cycle as sediments become an internal source of phosphate. Ferrous iron can then react with dissolved sulfides to form iron sulfide minerals such as mackinawite (FeS), whose interactions with PO43- remain largely unexplored. We investigate the role of FeS in the sequestration of PO43- under anoxic conditions, with or without natural organic carbon (OC). We show that Fes has a high affinity for PO43-, with a maximum sorption capacity comparable to moderately crystalline FeOx minerals. The presence of sorbed OC decreases the FeS affinity toward the PO43- by ~ 75%, which is attributed to the lower surface area of FeS-OC compared to FeS, electrostatic repulsion, and the reduced accessibility to reactive Fe(II) sites. Moreover, we show that upon exposure of FeS to oxic conditions, PO43- is efficiently recaptured by the FeS oxidation products (FeOx), hence highlighting a parallel self-sustaining reversible cycle resulting in the permanent sequestration of a small fraction of PO43-. Overall, these findings highlight FeS as a potentially important phosphate sink in anoxic freshwater sediments.
Prenatal testing has become an increasingly common practice in modern healthcare, offering parents valuable insights into the health and development of their unborn child. However, the rapid advancements in this field have also introduced a host of ethical dilemmas that demand careful consideration. Our objective was to explore the ethical considerations that the clinicians face in prenatal testing and genetic counseling, focusing on issues like informed consent, autonomy, the routinization of testing, disability rights, and implications for practice. A qualitative synthesis of the recent literature published until 2024 was conducted, and the data were organized, recapitulated, and presented to facilitate an integrated, comprehensive approach to prenatal counseling. We concluded that the integration of genetic and genomic testing into routine prenatal care is becoming increasingly common, assisting parents in making informed reproductive decisions. A key ethical concern is ensuring that they are fully informed to make independent choices about testing. Genetic counseling is vital for helping families understand the implications of testing options. However, disparities in access to these services can compromise the informed consent process. We propose a comprehensive approach to prenatal counseling to address these issues.
Online support groups (OSGs) offer a convenient way for patients with cancer and survivors of cancer to obtain information and support. However, not all OSGs are helpful, and in some cases, they may increase distress. Overall, there is a lack of clear evidence on the effects of OSGs, along with how and why they work. This study examined how, for whom, and in what contexts OSGs work for patients with cancer and survivors of cancer. A realist review of the evidence on cancer OSGs was conducted (12 databases, inception to February 15, 2025). We followed Pawson's steps and the RAMESES (Realist and Meta-Narrative Evidence Syntheses: Evolving Standards) quality standards for realist reviews. The Mixed-Methods Appraisal Tool was used to assess the quality of the evidence. Using a realist logic of analysis, we generated a narrative summary of the findings, context-mechanism-outcome configurations, and a program theory (eg, conceptual framework) to explain how cancer OSGs work. Additionally, we developed evidence-based recommendations for optimizing the effectiveness of OSGs. Of 16,659 papers identified, 168 were included. The evidence was organized into 3 categories, 10 concepts, and 57 context-mechanism-outcome configurations. Cancer OSGs can support patients by providing informational, emotional, appraisal, and altruistic support. This can lead to changes in distress, isolation, empowerment, and self-esteem, through negative and positive appraisals as well as coping efforts. These outcomes, however, depend on user attitudes about OSGs (ie, trustworthy, useful, culturally safe, and easy-to-use), how well the OSG fits their needs (ie, health need, sociodemographic or clinical characteristics, and coping style), and perceptions of control (ie, availability, anonymity, privacy, and autonomy). If an OSG was a good fit for a user's needs, whether they experienced positive outcomes depended on features of the communication technology (ie, modality, response time, and visual social cues), group composition and dynamics (ie, norms, moderation, safety, cohesion, and belonging), and the nature and content of interactions (ie, emotional expression, cognitive processing, and empathetic responses). These factors trigger underlying mechanisms such as feeling understood, accepted, cared for, valued, reassured, informed, and confident, which result in positive outcomes. OSGs can address supportive care needs and improve psychosocial well-being for patients with cancer and survivors of cancer. However, outcomes depend on specific contexts and mechanisms that impact how well OSGs meet patients' needs. To optimize effectiveness of OSGs, we recommend (1) helping to assess fit and address specific needs; (2) demonstrating trustworthiness; (3) enhancing anonymity and control, and protecting privacy; (4) enhancing ease-of-use; (5) supporting connection and belonging; (6) encouraging activity; (7) enhancing the nature of content shared to boost therapeutic effects; and (8) monitoring and adjusting design and management strategies.
Diabetic foot ulcers are serious skin wounds that affect many people with diabetes, often leading to severe infections or even the loss of a limb. This paper explores how artificial intelligence -computer programs that can learn from data-is changing the way doctors find and treat these wounds. By reviewing 68 recent studies, we looked at how these smart technologies analyze different types of medical images to help patients. Our findings show that AI can help doctors identify health risks much earlier than traditional methods. These computer tools are also excellent at measuring how a wound is healing and predicting which treatments will work best for each individual. Because AI can spot tiny patterns in images that the human eye might miss, it makes medical care more precise and consistent. In conclusion, using AI to manage diabetic foot wounds offers a powerful way to improve patient health. By helping doctors make better, data-driven decisions, this technology can lead to faster healing and reduce the risk of serious complications for people living with diabetes.
In the current global context, as society continues to evolve, the increasing demand for healthcare services poses significant challenges to the quality of care. Patient experience is regarded as a crucial factor that not only enhances individual satisfaction but also directly impacts the performance of the healthcare system. Prioritizing patient experience is key to the success and sustainability of an organization, helping to establish and maintain a competitive advantage. This study is to evaluate the proportion of patients with a positive experience and the factors associated with patient experience during inpatient treatment. A descriptive cross-sectional study was conducted on 347 inpatients at the University Medical Center, Ho Chi Minh City, Vietnam, from March to May 2024. Data were collected through direct interviews with participants using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questionnaire to evaluate patient experience. Among the 347 patients participating in the study, aged between 35 and 55 years, 83.6% reported having a positive experience, while 16.4% reported a negative experience during their inpatient treatment. Factors such as nursing, doctor, hospital environment, timely hygiene, and medication information were highly rated, with the overall experience ranging from 88.9% to 99.7%. Educational level, emergency admission, and length of hospital stay were statistically significant factors associated with patients' experiences. Our study emphasizes the critical importance of healthcare quality and patient satisfaction by evaluating their experiences during treatment. The attentiveness of healthcare staff and the hospital environment are also significant factors that contribute to enhancing the patient experience. This highlights the need for continuous improvement in the measures implemented to maintain and elevate the quality of healthcare services.
Background: Isolated Generalized Dystonia (IGD) severely reduces quality of life. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is effective for refractory IGD, but the factors influencing efficacy remain unclear. Methods: Twelve IGD patients treated with bilateral STN-DBS (2016-2021) were retrospectively analyzed. Clinical outcomes (BFMDRS, HAMA, HAMD, MOCA, MMSE) were evaluated at baseline and the last follow-up (12-60 months). The electrode position and volume of tissue activated (VTA) in STN subregions were analyzed using Lead-DBS V3.0. Results: STN-DBS significantly improved BFMDRS-M and BFMDRS-D scores (p < 0.001) without cognitive or mood deterioration. BFMDRS-M improvement correlated positively with the VTA of the whole STN and motor subregion (p < 0.05) but not with associative/limbic subregions. The preoperative HAMD score was negatively associated with motor improvement (p = 0.002). Conclusions: STN-DBS safely improves motor function in IGD. Efficacy depends on the VTA within the STN sensorimotor subregion. The preoperative HAMD score may predict the long-term outcome, helping guide patient selection and surgical planning.
Mormyrus kannume were collected from the Nile River in Assiut Governorate. Then, the fish were kept at approximately 26-28 °C with a 12 h/12 h light-dark cycle in a tank (100 L) for two weeks to acclimatize to laboratory conditions. Despite the economic importance of Mormyrus kannume in African freshwater fisheries, especially in the Nile River, no prior studies have documented its baseline morphohistology of key organs, such as the liver, or biochemical parameters or health biomarkers. This study fills this gap by characterizing normal hepatic architecture, liver enzyme activities, and histochemical components in wild Nile River specimens, providing a broad view of the fish's health status and helping researchers in their future studies. Hepatocytes exhibited cord-like arrangements with vesicular nuclei, intermingled with sinusoids of different shapes. Melanomacrophage centers varied in shape, location, and pigmentation. These findings establish reference physiological biomarkers for health assessment and future research on this species.
Fever is a hallmark of malaria. Several studies have linked febrile temperatures to reduced parasite viability, but also to increased cytoadhesion, a key driver of pathology. However, different mechanisms have been proposed to cause changes in cytoadhesion and parasite sensitivity to heat. Here, we demonstrate that exposure of Plasmodium falciparum-infected red blood cells (iRBCs) to physiologically relevant febrile heat stress (39 °C), derived from patient data, enhances cytoadhesion through increased trafficking of the major virulence factor PfEMP1 to the iRBC surface. This phenomenon is not limited to PfEMP1 and common laboratory strains, as it extends to the surface nutrient channel PSAC in four clinical isolates of diverse geographic origin. The increased surface protein display occurs without changes in overall protein expression or parasite developmental progression. Using phosphoproteomics and proximity labelling, we find that elevated temperature also increases trafficking and phosphorylation of exported proteins into the RBC. Enhanced export is likely reliant on the presence of a transmembrane domain as shown by NanoLuc reporter assays. Collectively, our results indicate that febrile temperatures commonly experienced during infection can accelerate protein export, likely at the parasitophorous vacuole. This enhanced export following heat stress is relevant because increased cytoadhesion could influence disease severity through earlier iRBC sequestration and elevated bound parasite mass. A fever usually indicates that the body is fighting an infection. In malaria, parasites infect red blood cells, and high temperature is a common symptom. Fever may slow parasite growth, but it may also increase levels of a parasite protein called PfEMP1 on the surface of infected cells. PfEMP1 makes these cells sticky, helping them attach to blood vessel walls and avoid removal by the spleen. This adhesion can worsen disease by blocking small blood vessels, including those in the brain. If the fever increases this stickiness, it could worsen symptoms. However, previous studies used to vary temperatures, leading to conflicting results. Jones et al. tested whether a common fever temperature (39 °C) affects PfEMP1 levels and cell adhesion. Using infected human red blood cells, they found that 39 °C increases both adhesion to proteins found on blood vessel walls and the number of cells displaying PfEMP1 on their surface. To investigate the process behind this increase, they used techniques to measure the activity of proteins and their interactions with other human proteins. They showed that heat accelerates the export of certain parasite proteins to the red blood cell surface, including PfEMP1 and likely others, without increasing overall protein levels or parasite growth. These findings suggest that fever may accelerate the surface export of certain parasite proteins, which unintentionally help infected cells adhere more strongly and earlier to blood vessels, potentially worsening the disease. However, further work is needed to confirm this in more realistic settings and to link it directly to disease severity in patients.
To provide a comprehensive summary of a decade (2014-2025) of high-quality research from Q1-Q3 journals on formulation development and improved drug-delivery methods for vulvovaginal candidiasis, addressing the limits of conventional antifungal therapy. A detailed narrative review was carried out using PubMed, Scopus, Springer, Wiley, Frontiers, ClinicalTrials.gov, and Google Scholar. To maintain scientific rigor, only the most relevant Q1-Q3 indexed publications were included. Studies published in the last eleven years have been evaluated for their relevance to vaginal drug delivery systems and anti-fungal formulations. Data were systematically retrieved and described in text and tables, with 203 formulation techniques given, including nanoparticles, vesicular carriers, mucoadhesive systems, thermosensitive gels, electrospun nanofibers, microneedles, and three-dimensional printed dosage forms. The key outcomes examined were vaginal retention, drug release behavior, mucosal penetration, antibiofilm activity, and antifungal efficacy. In comparison to conventional formulations, advanced drug-delivery systems displayed longer vaginal residence time, sustained drug release, and improved tissue penetration. Nanoparticle-based and mucoadhesive systems demonstrated increased antifungal effectiveness against both microbial and biofilm-associated Candida species, with absolute fungal clearance improvements ranging from 25 to 45% in preclinical applications. This review combines eleven years of formulation research, minimizing the need for readers to sift over fragmented literature. Major limitations included study design variability and a lack of long-term clinical data. This 11-year synthesis identifies improved drug-delivery technologies as promising patient-centered solutions for overcoming resistance, recurrence, and poor drug retention in VVC treatment. These drug delivery systems constitute an important step toward next-generation antifungal therapy and better clinical outcomes. This review summarizes 11 years of research on new drug delivery systems for vaginal yeast infections. Advanced formulations improve vaginal retention, enable controlled drug release, and show better antifungal performance than conventional treatments, helping reduce recurrence and resistance.
In this work, we show that by coupling in situ spectroscopic ellipsometry with a molecular beam epitaxy growth chamber, the growth parameters of ternary compounds with potential for quantum and spintronic applications can be immediately ascertained during the entire growth cycle of a sample. Initially, several films of (Bi x In1-x )2Se3 with stoichiometries ranging from x = 0 to x = 1 were grown and characterized by X-ray reflectivity, X-ray photoelectron spectroscopy, and Rutherford backscattering. Using this information, ellipsometry spectra were fitted by representing the dielectric functions with Kramers-Kronig-consistent oscillators. Consequently, composition-dependent dielectric functions of (Bi x In1-x )2Se3 were parametrized to create a material file that determines the Bi content of an unknown (Bi x In1-x )2Se3 film. By using this material file, therefore, both the Bi content and thickness of a (Bi x In1-x )2Se3 film can be obtained immediately at any stage of the growth cycle. We tested the model for universality among MBE growth systems and found that the model was transferable between systems. Furthermore, the generalized model allowed us to monitor sticking and desorption coefficients for Bi2Se3 thin films in operando for the first time, with significant implications for quantum and spintronic applications by enabling more reproducible and controlled device fabrication, advancing the understanding of emergent physics, and helping address future societal bottlenecks in electronic performance and demand.
Ambient artificial intelligence (AI) scribes for chart documentation have seen rapid adoption in clinical practice, but their educational impact on medical students has not been described. The purpose of this study is to determine the impact of an AI scribe on pre-clerkship medical student note writing. In this prospective non-randomized pre/post design study, all first-year medical students (n=104) at a single U.S. medical school submitted "human-only" notes based on a summative observed structured clinical examination (OSCE) station in May 2025. An AI scribe generated independent AI notes post-OSCE from recorded audio. A sub-group of students (n=47) consented to complete a second "hybrid" note by revisiting their human-only note and incorporating AI notes as perceived necessary, followed by a brief survey about the AI notes. Trained, blinded fourth-year medical student raters were randomly assigned to score all notes on 10 elements using QNOTE acceptability criteria (0=Unacceptable, 50=Partially, 100=Fully). A post-hoc, exploratory element-level review was then conducted. Across all elements, median evaluation scores of human-only notes were high (range 81.3 - 100) and were similar between students who participated in "hybrid" notes and those who did not. In paired analyses between "human-only" and "hybrid" notes, the only notable element-level change was a decline in Chief Complaint scores (P=.05). Symptom duration was omitted in the Chief Complaint section in 8 of 47 (17%) AI notes. No score differences were observed in QNOTE elements requiring documentation of pertinent findings and prioritized lists. Participants agreed that the AI note "was more concise than my note" (37/47, 79%) and would be "helpful as a first draft" (31/47, 66%); 26 out of 47 (55%) agreed that the AI note "left out important details", and 10 out of 47 (21%) agreed that the AI note "may reduce my ability to learn how to write a good note." Interaction with AI notes among pre-clerkship medical students had little impact on quality of "hybrid" notes. Chief Complaint scores likely declined due to conciseness in AI notes that often omitted symptom duration. Our findings suggest that among students who predominantly write close to fully acceptable "human-only" notes, there was no detriment to clinical reasoning, and students were discerning in balancing AI's conciseness and its omissions. The lack of impact on note quality may have been due to the workflow employed in this study, in which students were required to generate independent judgments before exposure to AI-generated content. Future work must explore longitudinal use of such tools using standard workflows seen in clinical settings, where AI notes serve as true first drafts. Especially for lower-performing students, AI scribes could enhance students' own note writing, though educational safeguards are necessary given the potential for harm due to overreliance on automated systems. The study was granted approval by the Yale School of Medicine Committee to Review Student Participation in Research on January 14, 2025, and an exemption from full review due to the minimal-risk educational nature of the project by the Yale Human Research Protection Program on January 23, 2025 (IRB Protocol ID 2000039478).
Activating transcription factor 4 (ATF4) is a master transcription factor of integrated stress response (ISR), an evolutionarily conserved intracellular signaling network that helps the cell, tissue, and organism to adapt to various unpredictable environmental fluctuations, mitigate the challenges, and maintain health. Stress-induced ATF4 expression regulates a wild variety of gene expression programs to enable stress management and repair for cell homeostasis and integrity. However, chronic ATF4 activation contributes to pathologies including cancer, inflammation, and neurodegeneration. Extensive studies have revealed that ATF4 regulates many cellular processes including autophagy, apoptosis, metabolism, and inflammation. Emerging evidence has uncovered new signaling pathways in regulation of ATF4 expression and activation, including at transcriptional, translational, and post-translational levels, and new functions of ATF4 in the progression of various metabolic and stress-related diseases, including inflammation, cancer, and cardiovascular disease. The diversity of ATF4 functions is increasingly appreciated. This review summarizes the recent findings of the complex regulatory network of ATF4 activity and its roles in integrating stress responses, metabolic reprogramming, unfolded protein responses, autophagy, inflammation, and immunity.
Birth trauma is a common experience, with 50% of birthing individuals perceiving their birth as traumatic. Using interpretive phenomenological analysis with an intersectional feminist trauma lens, this study aimed to understand how people experience healing from birth trauma. Eleven participants, who self-identified as having experienced and healed from a psychologically traumatic birth, were recruited. Data were collected through in-person interviews, follow-up phone interviews, and optional focus groups. The study identified five key themes related to the experience of healing from birth trauma: (1) seeking and strengthening support, (2) creating community and sharing stories, (3) empowerment as reframing the narrative and returning to self, (4) giving birth again, and (5) healing over time. The participants sought support from partners, friends, family, and healthcare providers, with some seeking professional therapy and medication. Creating communities and sharing stories, both in-person and online, helped reduce isolation and validate their experiences. For most participants, giving birth again was a major component of healing, providing opportunities for self-advocacy, regaining control, and experiencing patient-centered care. Empowerment is a key healing experience involving reframing narratives and self-acceptance. Healing was experienced as a nonlinear process over time, with moments of realization and reflection. Findings suggest that while psychological intervention is sometimes accessed, sharing stories, creating a community, and strengthening support systems over time are key components in moving forward from birth trauma. Interventions should integrate peer-led support and focus on reducing isolation and promoting community for those with birth trauma.
Copy number variations (CNVs) are a major source of structural genomic diversity that influences adaptation, reproduction, and production traits in livestock. The Black Bengal goat, an economically important Indian breed known for its high fecundity, superior skin quality, and resilience to humid tropical climates, was studied to uncover its structural genomic landscape. We performed whole-genome CNV analysis using high-depth (10×) sequencing data from eight individuals. A total of 31,816 copy number variants (CNVs) were identified, predominantly duplications, with an average length of approximately 45 kb. These CNVs were combined into 8910 copy number variation regions (CNVRs) covering approximately 0.15 Gb (about 5.3% of the autosomal genome). CNVR hotspots were mainly located on chromosome 1. Gene annotation showed that regions overlapping with CNVs and CNVRs contained more than 1987 protein-coding genes involved in pathways related to immunity, reproduction, metabolism, and extracellular matrix (ECM) organization. The presence of CNVs involving genes such as GDF9 and BMPR1B on chromosomes 7 & 6, respectively, is important because it indicates that the breed has a high reproductive capacity due to dosage-sensitive duplications. Changes in the extracellular matrix and increased dermal strength have been linked to duplications of genes such as COL6A1, LAMC2, LAMB3, FMN1, and CLDN1. This helps explain the superior hide quality of the breed. This research offers a comprehensive map of CNVs and CNVRs within the genome of the Black Bengal goat. It demonstrates how these duplications lead to structural changes that enhance both reproductive performance and skin resilience. These findings provide a valuable genomic resource for future marker-assisted selection, comparative genomics, and conservation breeding programs aimed at preserving indigenous goat populations.
We conducted Alliance clinical trial A231701CD that provided breast cancer patients a decision aid (DA) before their surgical consultation with the goal of improving engagement in decision-making. We report a mixed-methods analysis from patients who received the DA to understand patients' experiences in preparing for their consultation. Patients were included in this analysis if they were randomized to the DA arm (n = 331) and agreed to receive the DA (n = 195). Data collection included surveys before and after the consultation that assessed whether patients reviewed the DA and found it helpful, and reasons for non-review. We interviewed a subset of patients who had low engagement and experienced a preparatory barrier. We used descriptive statistics to summarize survey responses and content analysis to analyze interview data. Seventy-three percent (n = 143) reviewed the DA before the consultation. The majority (93%) said they would recommend receiving information via email. The most common reasons for non-review were logistical. Additional barriers included wanting to hear information directly from the surgeon, feeling they were already informed, wanting to stay in denial about their cancer, and perceiving information would be scary. Interviewees shared suggestions for clinics to optimize patients' review of information, such as explaining how preparing benefits patients and acknowledging emotion around cancer diagnoses. Our study highlights that breast cancer patients want information prior to the consultation, but patient-centered challenges can lead to non-review. When sharing pre-consult information, clinics should communicate how reviewing information can help patients feel less overwhelmed and improve their discussion with the surgeon. ClinicalTrials.gov Identifier: NCT03766009 (12/4/2018).
Prosthetic components from high-income countries (HICs) are often replaced not because they are broken, but because of guidelines or expired warranties, meaning they may still be usable. As most HICs classify prostheses as single patient multi-use devices, components are often disposed of or donated to low- and middle- income countries (LMICs) where medical device regulatory frameworks are limited or non-existent. A lack of standards guaranteeing the quality of donated prosthetic components could lead to a violation of the World Health Organization's principles of good donation. Here, we work towards the creation of a set of standards by quantifying the efficacy of a second-hand donated prosthetic foot quality checklist developed by STAND. We compared 170 checked to 196 unchecked feet received by prosthetic and orthotic centres in Fort Portal, Uganda, and found checklist implementation increased the percentage of usable feet from 83.16% to 94.12%. Foot brand significantly affected usability, but further data and samples are needed to disentangle the effects of prosthetic foot brand, prosthetic foot model, and centre from which the feet originated on prosthetic foot usability. We propose a rapid and efficient quality assurance checklist as a first step towards a set of standards towards prosthetic foot reuse and discuss future research directions. Research towards the creation of an international set of standards/regulatory requirements governing the use of prosthetic limbs, like the international standards used for prosthetic limb design, would not only enable the safe, useful provision of prosthetic components in LMICs, but would also set the groundwork for understanding how a repair, reuse, and recycle model for prosthetic components might be implemented in HICs. Globally, this could decrease prosthetic provision time, create a circular economy for prosthetic components, and reduce the carbon footprint of prosthetic component manufacture and provision.